MEASURING WHAT CHAPLAINS DO

Health Progress, Mar/Apr 2004 by Shook, Randy, Fojut, Laurie

A New Study Sheds Light on Chaplain Competencies and Productivity

In 2001, Catholic Health Initiatives (CHI), Denver, launched an 18-month study of chaplain performance and productivity. The findings-including a widespread lack of clarity and consistency in the understanding and measurement of what chaplains do-led CHI, one of the nation's largest Catholic health care systems, to make a set of recommendations to the spiritual/pastoral care departments at its hospitals and long-term care facilities in 19 states. As CHPs facilities act on those recommendations, their chaplains are learning to better define their roles, to articulate their duties, and to foster recognition of their contribution to patient care.

"Chaplains are often exhausted by the demands of their daily work, yet unable to explain exactly what they do or how they make a difference to patients or to their organizations," said Fr. Gerard T. Broccolo, STD, CHFs vice president of spirituality. "The inability to articulate what you do in a way that others can understand can be terribly harmful. Chaplains need to understand their value to their organizations and to the health of the patients and coworkers they serve."

Jim Gunn, clinical/pastoral education supervisor at Penrose-St. Francis Health Services in Colorado Springs, CO, has studied spiritual assessment for 20 years and believes that many chaplains are not fully aware of how their activities contribute to their organizations. "As a result, they often underreport what they do," he said. "In addition, administrators are often content with the symbolic nature of the chaplain's rolethe fact that they represent the values of the organization. The role of a chaplain is far greater, but that won't be widely understood until chaplains learn to report the full scope of their activities."

Cathy Wendt, mission leader and director of spiritual services at Franciscan Villa, a long-term care facility in South Milwaukee, WI, uses a metaphor to explain the perception of chaplaincy in many health care organizations. "There is still an idea that we're the icing on the cake, not part of the batter," she said. "Nurses refer residents to us because they know we can help them deal with many issues. But they don't see us as part of a patient's therapy-as professionals who deal with a resident's spiritual care needs while they deal with physical care needs. Fortunately, perceptions can change."

STUDY GOALS

In instigating its study, Measures of Chaplain Performance and Productivity (published in June 2002), CHI's Task Force on Chaplain Performance and Productivity Measures sought to define:

* A common language to describe what chaplains do

* The typical outcomes of their work

* The most appropriate ways to measure their productivity

"Organizations measure what they value, and they value what they measure," Fr. Broccolo said. "Catholic health organizations value spiritual care. The question is: What is the best way to measure it? We know how to count, but do we know what to count?"

Fr. Broccolo noted that most measures of chaplain productivity are based on volume statistics, such as the number of patient visits made each day. "The problem is, that type of measurement cannot capture the depth and breadth of the competencies chaplains need to serve patients, families, and their fellow caregivers," he said. "It also cannot account for the complexity or time required to deliver specific chaplaincy services, which range from giving sacraments to supporting individuals through the last days of life. It is entirely possible that the chaplains who see the greatest number of patients in a day are not able to provide the quality of spiritual care that they or their patients would like."

To begin to answer the measurement question, the CHI study team surveyed chaplains to determine their daily tasks and their ideas for appropriate productivity and performance measures. "We saw widespread diversity and subjectivity of perception about what chaplains do and how it should be measured," Fr. Broccolo said. "In addition, we saw that many chaplains have a difficult time articulating what they do, which makes it very difficult for other health care professionals to understand their role."

In the study's second phase, the team surveyed family members of patients who had recently died in CHI facilities to determine their satisfaction with chaplaincy services at the time of the patient's death. "As far as we know, this is the first time a health provider has gathered this type of chaplain performance data," said Fr. Broccolo. "The data clearly show that families see chaplains as surrogate family members who help them cope with the death of a loved one. This affirmed the value of chaplains as care team members who tend to patients' needs for comfort and spirituality."

The survey also had some findings that Fr. Broccolo found startling. "Many of the people surveyed didn't know if they actually met a chaplain or not," he said. "We saw that chaplains had to take part of the responsibility for fuzzy perceptions of their roles. The problem is that fuzzy perceptions are not conducive to clear productivity and performance expectations or assessments for chaplains."